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PDA Device Closure with and without Arterial Access

Ali A Al-Akhfash,Abdulrahman A Almesned and Abdullah Alqwaiee

Background: PDA device closure can be performed without an arterial access. We are presenting our experience in closing the PDA with and without arterial access.

Methods: From February 2012 till August 2014, all patients underwent transcatheter PDA closure were included. Detailed echocardiographic evaluation of the heart with hemodynamic doppler assessment was performed.

Results: During the period, 45 patients underwent PDA device closure. All have venous access, 14 patients (31%) have additional arterial access. Since 2013 our protocol is to do PDA device closure without an arterial access except in selected patients when arterial access was considered necessary. Pre-procedure angiograms were performed in tow projections by the venous catheter positioned at the PDA descending aorta junction in 32 patients (71%), and by the arterial accessed catheter in 13 patients (29%). PDA was closed by ado1 device in 25 patients (56%), Oculotech PDA device in 18 patients (40%), and by coils in 2 patients (4.4%). Post PDA device angiograms were performed through the side port of the long delivery sheath. Detailed echocardiographic assessment was performed 2 hrs to 4 hrs after intervention as well as in the next day. No major immediate complications. One patient developed mild pericardial effusion 24 hrs after the procedure. Comparing the differences between those with and without arterial access revealed that the procedure time, the fluoroscopic time as well as the amount of the contrast dose used were less in those with no arterial access.

Conclusion: PDA device closure without an arterial access can be performed safely and effectively by experienced interventionist. Patient selection and appropriate pre-intervention detailed echocardiography and procedure planning are essential for accomplishing device closure of PDA. The procedure is simplified and many patients can be discharged on the day of the procedure.